THE BARIATRIC BODIES PROJECT A Dissertation Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in Sociology Corey Stevens December, 2018 THE BARIATRIC BODIES PROJECT Corey Stevens Dissertation Approved: Accepted: ______________________________ ______________________________ Advisor Interim Department of Sociology Chair Dr. Bill Lyons Dr. Clare Stacey ______________________________ _____________________________ Committee Member Interim Dean of College of Arts & Sciences Dr. Kathryn Feltey Dr. Linda Subich ______________________________ ______________________________ Committee Member Dean of Graduate School Dr. Susan Roxburgh Dr. Chand Midha ______________________________ Committee Member Dr. Manacy Pai ______________________________ Date ______________________________ Committee Member Dr. Isa Rodriguez-Soto ______________________________ Committee Member Dr. Mary Triece ii ABSTRACT How do bariatric patients make sense of the medical, aesthetic, and moral discourses related to fat, health, and illness? How are patients’ identities shifted as their bodies change throughout the bariatric surgery process? To answer these questions, I interviewed 35 bariatric patients at various stages of their bariatric careers. I divide my findings into three chapters. First, I describe the bariatric process using Goffman’s concept of the moral career and Foucault’s ideas about discipline. The moral career of the bariatric patient proceeds through 4 stages: the pre-surgery process, recovery, the honeymoon stage, and the struggle stage. I argue that bariatric surgery utilizes two types of disciplinary technology: (1) a discursive process where patients are socialized into health behaviors and must prove themselves morally worthy of surgery; (2) an embodied process where patients’ digestive tracts are modified to punish them for straying from “the program.” Next, I focus on the illness experience of bariatric patients. Before surgery, patients experience their bodies as chronically ill and lacking in freedom. They describe fitness and pain issues which limit their day-to-day mobility. They also count down their prescription medications as an important symbol of health and illness. After surgery, patients do not view the symptoms of bariatric surgery (such as vomiting, chest pain, diarrhea, constipation, hair loss, etc.) as illness but instead as worth it in the end, as something to adjust to, and as useful tools for weight loss. After that, I explore the relationship between health, appearance, and stigma, and how this relationship is iii impacted by intersecting identities of race, class, gender, and age. Bariatric patients describe their often-contradictory experience of the Western aesthetic of health; bariatric patients carry a highly visible fat stigma which is believed to convey their health status, yet they often view appearance as less important than health. Even after losing weight, many patients continue to carry a discreditable identity, in part due to the visible markers of their former obese status on their bodies—i.e., loose skin and plastic surgery scars. Finally, I tie my findings together using the concepts of obese embodied identity and bariatric embodied identity. I conclude with a discussion of the theoretical implications and limitations of this study and propose future research. iv DEDICATION To my mother, Kim H. Stevens “All the good in me is because of you.” – St. Vincent, “I Prefer Your Love” v ACKNOWLEDGEMENTS I want to acknowledge all the bariatric patients who shared their stories with me. I am so grateful to them for their willingness to be honest and vulnerable about one of the most intimate components of their selves—their bodies. I want to thank Dr. Shannon Perkins, whose advocacy was instrumental in allowing me access to bariatric clinic patients. I can honestly say that this research would not have been possible without her. I would also like to acknowledge Dr. Christina Rummel who was my contact on the inside of the clinic. She took time out of her busy schedule to show me the inner workings of the clinic. She was enthusiastic and supportive of my work from day one—which made recruitment go very smoothly. I am grateful to the joint graduate program at the University of Akron and Kent State University for giving me the space to develop my scholarship and find my voice as an academic. I want to thank all the professors who taught and mentored me as I developed my scholarship, especially Professors Clare Stacy, Susan Roxburgh, Adrian Frech, Stacy Nofziger, Tiffany Taylor, John Zipp, Cheryl Elman, Valerie Callanan, Juan Xi, Kathy Feltey, Stephen Webster, Kristen Marcussen, Kristen Mickelson, Richard Serpe, Rebecca Erikson, and Manacy Pai. I want to thank the committee who approved this study and offered helpful advice: Professors Clare Stacey, Kathy Felty, Susan Roxburgh, and Issa Rodriguez-Soto. I would also like to thank Professors Manacy Pai and Mary Triece for stepping in to complete my committee. vi I was to especially thank Dr. Clare Stacey. Her compassion helped me succeed during a very difficult time. She taught me so much about being a teacher and a researcher. Clare was with me through the dissertation process from start to finish and I could not have asked for a better advisor, teacher, and mentor. I also want to thank Dr. Kathy Feltey. As a teacher and a co-author, Kathy has given me space to develop as a qualitative, feminist methodologist. I truly feel that I transitioned from student to colleague through working with Kathy and the rest of the pioneer women’s project, who I Would also like to thank: Cheryl Elman, Barb Wittman, and Rauslynn Boyd. As the chair of the Women’s Studies Program at the University of Akron, Kathy provided me the opportunity to gain experience teaching in the women’s studies classroom—which has expanded my feminist pedagogical praxis. More than that, Kathy has been a mentor and a friend during some difficult periods in both of our lives. For that, I am truly grateful. I also want to acknowledge my wonderful graduate colleagues who mentored me, made me laugh, and put up with a whole lot of crying. I want to thank all the collogues who indulged my short-lived attempts at forming writing groups; their feedback helped me to develop as a writer. I want to thank Peter Barr, Marci Cottingham, Dani Jauk, Jodie Henderson-Ross, Mike Steiner, and all the graduate students who took the time to mentor me. I’m grateful to my collogues at ABIA: Mike Steiner, Peter Barr, and Michael Rickles, the best coworkers a public health scholar could ask for. I want to thank my cohort for being my rocks throughout this process: Will LeSuer, Rania Isa, Kristen Santos, Brooke Long, Fritz Yarrison, Lenzy Jones, Kelsey Risman, Jackie Town-Roese, vii and Terry Mortenson. I honestly cannot name here all of the people in this program whose friendship propelled me through my graduate career. I wish them all nothing but success in and out of academia. I especially want to thank Will LeSuer, my most steadfast office companion and one of my dearest friends. We put together major events through frayed nerves, worked through difficult problems both in and out of work, and spent a lot of time distracting each other from our work. Everyone knew that they could count on Will to complete a delegated task or help them through a tough stats problem. He could help you navigate the bureaucracy and point you to the resource that you needed. More than that, Will would offer a shoulder to cry on if you needed one. Will is one of my dearest friends and I hope to continue to collaborate and confide in them for years to come. I also want to thank Jodie Henderson-Ross who has been a friend and mentor through her own transition from student to faculty. I could always count on Jodie to put things into perspective when I felt myself getting lost in the all the bullshit of the bureaucratic machine and careerist discourses. Jodie inspires me to be both bold and vulnerable in my work and life. She inspires me to not forget to prioritize my community, my loved ones, and my sanity. Jodie is the radical, brilliant institutional changemaker and community leader that we should all aspire to be. Jodie and her daughters—Mikaia and Jahara—have brought me so much joy and inspire me every day. I want to acknowledge the professionals and organizations who helped with the work. I participated in online support communities: The National Center for Faculty viii Development and Diversity “Faculty Boot Camp” and alumni program, and the “Unstuck” program provided by The Professor Is In. Both of these organizations helped give sound advice to balance my work and life and provided a community to keep moving forward through the most isolating parts of the dissertation. I want to thank Tiffany Taylor and Isa Rodriguez-Soto for recommending these websites to me. Financial support for this project was supplied in part by the Barbara J. Stephens Dissertation Award—no relation. I’d like to thank the graduate committee for this generous award. Professional transcription was provided by Issac Kongo; I would like to thank him for his diligent work and his patience. I would like to thank Carmen Tracey for their skillful editing. Working with them has been wonderful and I hope to continue to work with them in the future. I also want to thank my therapist, Melissa Kovach, who helped me work through my issues with anxiety and depression and finally finish my dissertation. On that note, I want to acknowledge Lafayette College for providing me with stable income and health insurance. Link and Phalen are right: privilege and power make all the difference. I want to thank my supportive colleagues at Lafayette College, especially my chair Professor Andrea Smith. I want to thank my family for their support.